Details Of Revisions Research Articles

Surgery for Spinal Stenosis in Achondroplasia: Causes of Reoperation and Reduction of Risks.

Individuals with achondroplasia are prone to symptomatic spinal stenosis requiring surgery. Revision rates are thought to be high; however, the precise causes and rates of reoperation are unknown. The primary aim of this study is to investigate the causes of reoperation after initial surgical intervention in individuals with achondroplasia and spinal stenosis. In addition, we report on surgical techniques aimed at reducing the risks of these reoperations. A retrospective review was conducted over an 8-year period of all patients with achondroplasia at a single institution that serves as a large referral center for patients with skeletal dysplasias. Patients with achondroplasia who underwent spinal surgery for stenosis were identified and the need for revision surgery was studied. Data collected included demographic, surgical, and revision details. Fisher exact test was used to determine if an association existed between construct type and the need for revisions. Thirty-three of the 130 (22%) patients with achondroplasia required spinal stenosis surgery. Twenty-four individuals who met the criteria were selected for analysis. The initial spine surgery was at an average age of 18.7 years (SD: 10.1y). Nine patients (38%) required revision surgeries, and 3 required multiple revisions. Five of 9 (56%) of the revisions had primary surgery at an outside institution. Revision surgeries were due to caudal pseudarthrosis (the distal instrumented segment) (8), proximal junctional kyphosis (PJK) (7), and new neurological symptoms (7). There was a significant association found between construct type and the need for revision ( P =0.0111). The pairwise comparison found that short fusions were significantly associated with the need for revision compared with the interbody group ( P =0.0180). PJK was associated with short fusions when compared with the long fusion group ( P =0.0294) and the interbody group ( P =0.0300). Caudal pseudarthrosis was associated with short fusions when compared with the interbody group ( P =0.0015). Multivariate logistic regression found long fusion with an interbody was predictive of and protective against the need for revision surgery ( P =0.0246). To date, none of the initial cases that had long fusions with caudal interbody required a revision for distal pseudarthrosis. In patients with achondroplasia, the rate of surgery for spinal stenosis is 22% and the risk of revision is 38% and is primarily due to pseudarthrosis, PJK, and recurrent neurological symptoms. Surgeons should consider discussing spinal surgery as part of the patient's life plan and should consider wide decompression of the stenotic levels and long fusion with the use of an interbody cage at the caudal level in all patients to reduce risks of revision. Level IV-Retrospective case series.

Reconsidering "Critical" Bone Loss in Shoulder Instability: 17-Year Follow-Up Study following Arthroscopic Bankart Repair.

Glenoid bone loss is a risk factor leading to the failure of arthroscopic Bankart repair. While 20-25% glenoid bone loss has long been considered the level to necessitate bony augmentation, recent studies indicate that 13.5% has a "subcritical" glenoid bone loss level, which is associated with decreased short- and medium-term functional scores. Few researchers worked on the long-term effect of "subcritical" or even less severe degrees of glenoid bone loss on redislocation rates and functional outcomes after arthroscopic Bankart repair. This study aimed to evaluate the effect of subcritical or less severe glenoid bone loss on redislocation rates and function after arthroscopic Bankart repair. A patient cohort who had undergone computed tomography (CT) of glenoid bone loss and arthroscopic Bankart repair over 15 years ago was reviewed. Western Ontario Shoulder Instability (WOSI) score, Single Assessment Numeric Evaluation (SANE) score, redislocation after operation, mechanism of recurrence, and revision details were reviewed. Seventy-five patients were reassessed 17.6 ± 1.9 years following initial surgery. The age at enrolment was 26.8 ± 8.3 years. Twenty-two (29%) patients of the 75 patients had a redislocation on long-term follow-up, though this was not related to glenoid bone loss severity. The impaired functional score was found in patients with initial glenoid bone loss of 7% or more on long-term follow-up: WOSI (physical symptoms): 0.98 ± 2.00 vs 2.25 ± 4.01, p=0.04 and WOSI (total): 0.79 ± 1.43 vs 1.88 ± 3.56, p=0.04. At a mean of 17.5 years following arthroscopic Bankart repair, redislocation occurs in over a quarter of 75 patients, and they are not related to initial glenoid bone loss severity. Impaired functional outcome is apparent in patients with initial glenoid bone loss of >7%, though this impairment does not seem sufficiently severe to warrant an alternative treatment approach.

Outcomes following total ankle total talus replacement: A systematic review

BackgroundProsthetic substitution of the talus presents a significant challenge to the foot and ankle surgeon. The shear and compressive forces on the talus and its tenuous blood supply lead to high rates of avascular necrosis and eventual talar collapse. The purpose of this systematic review is to evaluate whether total ankle total talus replacement (TATTR) leads to improved clinical and radiographic outcomes with appropriate safety metrics in patients with a history of avascular necrosis or significant trauma. MethodsWe searched the concepts of talus, prosthesis, and arthroplasty in MEDLINE (PubMed), Embase (Elsevier), CINAHL Complete (EBSCOhost), and Scopus (Elsevier) from the database's inception through March 9, 2023. Inclusion Criteria were 1) previous trauma to the talus, 2) post-traumatic arthritis to the tibiotalar joint, 3) avascular necrosis of talus, 4) multiple failed prior interventions, 5) degenerative osteoarthritis to the tibiotalar joint, and 6) inflammatory arthropathy to tibiotalar joint. Patients less than 18 years of age and manuscripts in non-English languages were excluded. ResultsOf the 7625 references, 16 studies met the inclusion criteria, yielding data from 136 patients (139 ankles). The studies varied in design, with case reports and retrospective case series being predominant. The overall weighted average modified Coleman Methodology Score (mCMS) was 70.4 out of 100, indicating moderate flaws in study design that may be subject to various forms of bias and possible confounders. Demographics showed a diverse range of etiologies, with alumina ceramic being the primary prosthesis material. Functional scores demonstrated improvements in dorsiflexion and plantarflexion, although patient-reported outcome measures (PROs) were inconsistently reported. Complications included fractures, heterotopic ossification, prolonged wound healing, and infections. Revision details were sparsely reported. ConclusionTATTR is a promising treatment modality for improving short-term functional outcomes for patients with avascular necrosis or trauma-related issues. However, this systematic review underscores the need for standardized reporting, longer-term follow-ups, and further research to establish the procedure’s efficacy and safety, particularly in comparison to other treatment modalities. Level of EvidenceIII, Systematic Review of Level IV Studies

SIMILAR SURVIVORSHIP FOR UNCEMENTED MOBILE-BEARING AND CEMENTED FIXED-BEARING MEDIAL UNICOMPARTMENTAL KNEE ARTHROPLASTY BUT DIFFERENT REASONS FOR REVISION

Source of the study: University of Auckland, Auckland, New ZealandUnicompartmental knee arthroplasty (UKA) is effective for patients with isolated compartment osteoarthritis, however the procedure has higher revision rates. Long-term survivorship and accurate characterisation of revision reasons are limited by a lack of long-term data and standardised revision definitions. We aimed to identify survivorship, risk factors and revision reasons in a large UKA cohort with up to 20 years follow-up.Patient, implant and revision details were recorded through clinical and radiological review for 2,137 consecutive patients undergoing primary medial UKA across Auckland, Canterbury, Counties Manukau and Waitematā DHB between 2000 and 2017. Revision reasons were determined from review of clinical, laboratory, and radiological records for each patient using a standardised protocol. To ensure complete follow-up data was cross-referenced with the New Zealand Joint Registry to identify patients undergoing subsequent revision outside the hospitals. Implant survival, revision risk and revision reasons were analysed using Cox proportional-hazards and competing risk analyses.Implant survivorship at 15 years was comparable for cemented fixed-bearing (cemFB; 91%) and uncemented mobile-bearing (uncemMB; 91%), but lower for cemented mobile-bearing (cemMB; 80%) implants. There was higher incidence of aseptic loosening with cemented implants (3-4% vs. 0.4% uncemented, p<0.01), osteoarthritis (OA) progression with cemMB implants (9% vs. 3% cemFB/uncemMB; p<0.05) and bearing dislocations with uncemMB implants (3% vs. 2% cemMB, p=0.02). Compared with the oldest patients (≥75 years), there was a nearly two-fold increase in risk for those aged 55-64 (hazard ratio 1.9; confidence interval 1.1–3.3, p=0.03). No association was found with gender, BMI or ASA.Cemented mobile-bearing implants and younger age were linked to lower implant survivorship. These were associated with disease progression and bearing dislocations. The use of cemented fixed-bearing and uncemented mobile-bearing designs have superior comparable long-term survivorship.

Pinnacle Ultamet metal-on-metal total hip arthroplasty survivorship: average 10-year follow-up.

BackgroundIt is unclear whether a connection exists between femoral head size, offset, neck length, and cup abduction angles, and rate of revision in metal-on-metal (MoM) total hip arthroplasty (THA) implant systems.MethodsA retrospective review of MoM THA completed by a single surgeon with a single implant between 2003 and 2008 was conducted. Patient demographics, implant data, radiographs, and revision details were collected at follow-up. Incidence rates for revision and osteolysis were calculated in regard to the femoral head size, stem offset, neck length, and cup abduction angles.ResultsSix hundred and ninety two THAs were identified, with 79% of patients returning for a median follow-up of 10.3 years (interquartile range = 6.0-12.3). The median time to revision was 7.5 years (interquartile range = 5.3-9.9) among 27 total revision surgeries. The overall incidence rate of revision was 5.4 revisions per 1000 person-years, 3.0 revisions per 1000 person-years for adverse local tissue reaction. Hips with a cup abduction angle of ≤40° had revisions at nearly twice the rate of those with an angle of 41°-50° (incidence rate ratio = 1.98, 95% confidence interval: 0.92, 4.29). Hips with a 9 mm neck length had an increased rate of revision (incidence rate ratio = 5.94, 95% confidence interval: 1.33, 26.55) relative to those with a neck length of 0 mm. Rates of osteolysis were similar between implants of different head sizes, neck lengths and cup abduction angles.ConclusionsMoM implant systems with longer necks and smaller cup abduction angles may lead to increased need for revision. Results from this study suggest a need for closer long-term follow-up of MoM THA systems.

Arthroscopy combined with unicondylar knee arthroplasty for treatment of isolated unicompartmental knee arthritis: A long-term comparison.

BACKGROUNDKnee osteoarthritis is the most prevalent form of osteoarthritis and is becoming the main reason for progressive pain in knee joints. Arthroscopy combined with unicondylar knee arthroplasty (UKA) is one of the effective methods for the treatment of severe unicompartmental knee arthritis. This surgical approach gives us the capacity to explore all the articular cavities and plays a vital role in UKA patient selection. However, some scholars think that the surgical procedure is traumatic and may increase the rate of surgical infection, and its clinical efficacy needs further study.AIMTo compare the clinical effect of arthroscopy combined with UKA and UKA alone for patients suffering from unicompartmental osteoarthritis (OA).METHODSA retrospective study was conducted on patients who were diagnosed with unicompartmental OA (Kellgren–Laurence grade ≥ III) and underwent UKA between October 2012 and November 2006. The patients were followed at 3, 6, and 12 mo and every 2 years thereafter. During each follow-up, the radiographic materials, the range of motion of knee and hospital for special surgery (HSS) score, knee society score and knee function score as recorded, and the modes and time of failure and revision details were collected as well.RESULTSData on 104 patients (118 knees), including 54 patients (60 knees) in the arthroscopy combined with UKA group (group A) and 51 (58 knees) in UKA alone group (group B) were collected during an average follow-up duration of 7.25 years, excluding the cases who were lost to follow-up. At the final follow-up, 3 (5.0%) of 60 knees in group A compared with 4 (6.9%) of 58 knees in group B failed and converted to total knee arthroplasty, with no statistically significant difference between the two groups (P = 0.933). The percentage of patients receiving blood transfusion was 40% in group A, significantly lower than that in group B (67.2%; P = 0.003). Total volume of blood transfusion in group A was also significantly lower than that of group B (P = 0.001). Both groups improved significantly after operation in clinical symptoms and functions. HSS score, knee society score, and knee function score increased significantly at the latest follow-up compared to pre-operation in group A, from 59.6 ± 10.9 to 82.7 ± 9.3 (mean difference [MD], 23.2; 95%CI: 19.3-27.0; P = 0.000), 47.3 ± 6.3 to 76.2 ± 13.1 (MD, 28.9; 95%CI: 25.1-32.7; P = 0.000), and 57.5 ± 6.3 to 75.1 ± 19.6 (MD, 17.5; 95% CI: 12.1-23.0; P = 0.000); and in group B, from 59.3 ± 15.6 to 84.3 ± 10.1 (MD, 23.7; 95%CI: 18.9-28.5; P = 0.000), 49.1 ± 9.2 to 75.1 ± 13.2 (MD, 24.7; 95%CI: 19.9-29.5; P = 0.000), and 59.3 ± 9.0 to 77.4 ± 13.8 (MD, 17.2; 95%CI: 12.8-21.6; P = 0.000).CONCLUSIONArthroscopy combined with UKA and UKA alone both provide benefits in clinical symptom improvement and alignment correction. Arthroscopy combined with UKA does not increase the infection probability and surgical complications, and has an advantage in reducing the total volume of blood transfusion and the percentage of patients receiving blood transfusion.

Analysis the cause of failure in primary surgery of cubital tunnel syndrome and clinical evaluation of revision cubital tunnel surgery

Objective To explore the reasons for the failure of primary cubital tunnel syndrome (CuTS) surgery, summarize the technical details of cubital tunnel revision and evaluate the clinical efficacy. Methods From January 2015 to December 2016, 20 patients with persistent or new symptoms of CuTS after primary operation were treated with revision. The technical details of revision of cubital tunnel were summarized and the clinical efficacy was evaluated by observing the compression of ulnar nerve during operation and following up the improvement of clinical symptoms. Results The incomplete release of common compression points of ulnar nerve in elbow and improper preparation of fascial tissue flaps for anterior ulnar nerve were the main reasons for the failure of operation. After at least 12 months of follow-up, the strength of hand intrinsic muscles, skin sensation and pain symptoms of ulnar nerve innervation were significantly improved. Conclusion For the cases of CuTS with severe symptoms or new symptoms after primary operation, the main reason for failure is improper handling of details. The clinical efficacy of revision of CuTS is satisfactory, but it is worse than that of successful primary surgery. Key words: Cubital tunnel syndrome; Treatment failure; Revision; Neuropathic pain; Medial antebrachial cutaneous nerve

ANSI/ASA S1.20-2012, “Procedures for Calibration of Underwater Electroacoustic Transducers,” Revision Details

The ANSI/ASA S1.20-2012 standard, “Procedures for Calibration of Underwater Electroacoustic Transducers,” was released in February 2012. It is a revision of American National Standard S1.20-1988 (R2003). An overview of the content of this standard inclusive of the typical primary and secondary open water procedures for determining the measurable characteristics of free-field receive voltage sensitivity and transmitting responses are examined along with highlights of materials that are new to the 2012 revision. In this later category, this presentation provides overview information contained in the S1.20-2012 related to correction factor application (with an emphasis on extension cable usage) and introductory material on measurement uncertainty analysis (along with the identification of common error sources). A cursory look at the informational annexes will also be addressed with an emphasis on the 2012 revision-specific ones related to medium correction factors, nonlinear effects including cavitation, and a standard-target method for calibrating active sonars.

Mid-term survival following primary hinged total knee replacement is good irrespective of the indication for surgery

The use of 'hinged' knee prostheses for primary knee arthroplasty procedures is increasing. This analysis reports the rates of implant survival, modes of failure, revision details and functional outcomes with particular reference to the primary indication for surgery for a cohort of patients treated with primary hinged knee replacement. Systematic review with supplementary analysis using data from the National Joint Registry and Department of Health. Analysis included 964 patients undergoing primary hinged knee replacement between April 2003 and December 2010. Survival at a maximum of 7 years was calculated for the group as a whole and dependent upon the indication for surgery (osteoarthritis vs. rheumatoid/inflammatory arthritis vs. post-traumatic arthritis). Functional outcomes (pre- and post-operative Oxford Knee and Euroqol-5D scores and post-operative satisfaction) were available for 46 patients. In total, 20 cases required revision. The 5-year survival rate (96.8% [95% CI 95.1-98.4%]) was not dependent upon the primary surgical indication (p = n.s.). The commonest reasons for revision were infection (8 cases), peri-prosthetic fracture (4 cases) and aseptic loosening (3 cases). Patients reported substantial improvements in their Oxford Knee Score (mean improvement = 17.6, [95% CI 14.4-20.8]) and EQ5D index (mean improvement = 0.357, [95% CI 0.248-0.467]). Levels of post-operative satisfaction were high. Hinged knee replacement can be considered as a viable alternative to more traditional unconstrained designs in the complex primary setting. These findings are clinically relevant as they support the increasing use of hinged knee replacements for the arthritic knee in which there is concomitant severe bone loss, deformity or instability. Surgeons using these implants can have confidence that their mid-term performance is comparable to more conventional knee designs. Prospective cohort study, Level II.

Ballet for Martha: Making Appalachian Spring (review)

Reviewed by: Ballet for Martha: Making Appalachian Spring Deborah Stevenson Greenberg, Jan. Ballet for Martha: Making Appalachian Spring; written by Jan Greenberg and Sandra Jordan; illus. by Brian Floca. Porter/Flash Point/Roaring Brook, 2010. [48p.] ISBN 978-1-59643-338-0 $12.99 Reviewed from galleys R Gr. 3-5. The Martha of the title is legendary twentieth-century dancer and choreographer Martha Graham, and Greenberg and Jordan, noted chroniclers of art, here follow the artistic collaboration that created one of her best-known ballets, Appalachian Spring. Graham worked with composer Aaron Copland, who won a Pulitzer Prize for his score, and with sculptor Isamu Noguchi, who created the stage sets, to craft a "story of the frontier when pioneer families traveled west to put down roots." While it's tough to put together a few of the historical pieces here, the graceful, restrained text chronicles a process most people never see the inside of; the details of revision and collaboration are wisely chosen for effective illumination. Floca's art has some similarity to that of Robert Andrew Parker, illustrator of Greenberg and Jordan's Action Jackson (BCCB 11/02), in its slender linework and washes of watercolor hues; however, it's more trim and diagrammatic, evincing a delicate crispness that's subtly appropriate to Graham's vigorous aesthetic. This could make an interesting counterpart to Schubert's Ballet of the Elephants (BCCB 5/06), or, with additional information, an introduction to Graham and modern American art, especially if paired with Freedman's Martha Graham (BCCB 6/98) and the few extant film clips of Graham in action and conversation. The book closes with end matter including brief traditional biographies of Graham, Copland, and Noguchi; a bibliography; source notes; and a few black-and-white photographs of the principals. Copyright © 2010 The Board of Trustees of the University of Illinois

Alice Munro: Writing Her Lives by Robert Thacker

B o o k R e v i e w s Alice M unro: W riting Her Lives. By Robert Thacker. Toronto: Douglas Gibson/McClelland and Stewart, 2005. 603 pages, Can$39.99. Reviewed by D oug Werden West Texas A&M University, Canyon Robert Thacker’s biography of Alice Munro is the manifestation of a passion for Munro’s stories that captivated Thacker for more than thirty years. In read­ ing the book, it becomes difficult to determine what is most impressive: the fact that Thacker undertook the challenge of producing the biography of a living author or that he wrote such a thoroughly researched and beautiful account of her life as to give us what will surely become the authoritative literary biog­ raphy of Munro. As exemplified in the best biographies, Thacker’s gracious prose moves between archival sources and interviews so well that you are left appreciating the depth of research as well as the craft. Because Munro’s daughter, Sheila Munro, has explored the personal side of her mother in the memoir Lives ofMothers and Daughters: Growing Up with Alice Anne Langton. INTERIOR OF JO H N 'S HOUSE [LOOKING SOUTH], 1837. Graphite on cream wove paper. 18cm x 23.5 cm. Archives of Ontario. b o o k R e v ie w s 4 3 7 Munro (2001), Thacker focuses on Munro’s writing and publishing life, relying on the author’s archived papers, her correspondence, and local newspapers. In particular, he includes important information about the writers who encour­ aged her, agents who guided her, and editors who shaped her books. Although he read early drafts of many stories to prepare the biography, Thacker does not burden the reader with details of revision but summarizes key author/editor interchanges in order to illuminate the ways these conversations impacted Munro’s work. Given that his focus is on her professional life, Thacker resists the temptation to research or speculate about her private decisions. He briefly mentions Munro’s marital problems and fights at home but does not examine them closely. When he discusses her divorce in 1973, he does so in order to explain her motivation for moving from Victoria, British Columbia, to south­ ern Ontario, focusing on her relationship to place rather than to her husband. As many know, Munro spent twenty-three years (1949-1973) living in Vancouver and Victoria, where she published her first two books as well as many of her short stories. Thacker suggests place matters deeply to Munro and informs much of her prose. She says of her short fiction, “When I first started writing, setting meant more to me than people. This was really what I was writ­ ing about. ... I was just overwhelmed by a place” (158). Thacker’s attention to geography reveals her effort to consciously construct fictional places, resulting in settings that rival William Faulkner’s Yoknapatawpha County in their depth and complexity and bring rural and small-town Ontario to life. Munro is often quoted as saying that in her fiction “there is always a start­ ing point in reality” (529). However, Thacker avoids heavy-handed biographi­ cal interpretations, preferring to suggest possibilities and explore potential influences. He does not offer authoritative readings as much as provide scholars with new contexts for rereading Munro’s stories. The biography celebrates the intersection of Munro’s life and writings without making tired claims of reading her life through her fiction or reading her fiction through her life. While Thacker’s biography is intended for scholars exploring the nuances of her work, it is so well written that the non-scholar can easily gain insight into Munro’s work. A t a time when the short story gamers less and less of the public’s attention, Thacker’s work reminds us of the importance of the genre in defining who we are and how we live and the contribition Munro has made to both sides of the border and beyond. ...